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APPLICATIO^ FOR CONSTRU�Tt� N PERMIT <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT �— <br />259-8810 <br />!_l DEMOLITION I I COMBINATION <br />fAVNER ldNLADDRE55 _ <br />HEATING SYSTEM: J GAS J ELECTRIC J <br />BUILDING <br />I MECHANICAL <br />I^iP PHON[ <br />l\� l� L V�CL� <br />FLUMBING I SIGN <br />Q,S'i.�C�� � ���i�-'�.�� <br />IENANT IAAILMDDRE55 CILY . \ ]IP PHOIJE <br />�—a.��r+�hc�n �• v d�;�-���� <br />APCHiTELTORfES�GNER MAILAU RESS LiiY ZiP PMONE <br />G[NERALCOYTRACTOR MAllA0DRE5S CITV Zlo PNONE SipTELILENSEe <br />MECHANICALCONTRACTOR MAILADURF55 CITY IIP FHONE STATELILENSE• <br />��11��1C'� <br />PW6IBMGCONTRACTOR MAI�ADDRESS CITY 21P FMONE STATELIC[NSEa <br />CONiRACTPRICEOFWORN �/_� � <br />y 7"L/ <br />�FSGPIBE WORN �ND SOUARE FOOTh�c INYOLVED �ONTACT PERSON AND PHONE NO <br />PROPOSEO <br />LEGAl0E5CRIPTION OF PiiOPERN �SNOWN BELJW OR ATTAC4 T1V0 COP�ES� <br />LOT �LOCK OF <br />f�ARCEL TAX 1 G NUMBER <br />: nucTni iciiON LO�N LENDFN. �ODRESS. iELEPMONE NUMBER <br />TYPE OF <br />CLOSET <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />IAUNDRYTRAY <br />CLOTHES WASHER _ <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK (SERVICE—BAR. ETC.) <br />TOTAL 5 <br />UIT 5 <br />1L FEE S <br />FOR OFFICE USE ONLY: <br />FP.ONTSETBACK REI.RSETBACH <br />uSEZONE LorAPEA <br />iVCE OF WNST. NO.OF STORIES <br />SIZE JF BI�G FIR[ SPPINNLERS REO'0 <br />OCCUPANCYLOAD FIREAL�FMRE00 <br />REPSON <br />iNiANE BY <br />oATE <br />I HEREPV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRFCT. AlL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPF OF <br />WORK WILL BE COMPIETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES N0- PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROV�SIONS OF ANV <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTI�N OR THE <br />PERfORA1ANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICFTION IS MADE AND I COMP�Y WITH THE STAT[ <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />TVPE OF EOUIPA <br />A�C—AiHNDLG UNITS—H.P <br />FONCF.O AIR SYSTEMS—B <br />UNIT HEATEFS—B.T.U. M <br />GLOTHES DRVERS <br />VENTIL�TION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE (WOOC <br />FIREPLACEINSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTF�N <br />SIDESETB/CN PL4NLHECKNU�dBER PEE <br />vncnrur siTE FEES <br />' � YES � ' H� OUILDING <br />occonu�ov r,oarpw2m�,au�ns <br />cao:m p�UMBING <br />enSEMErv1 MECHANICAL <br />���YES ;�.NO <br />HEIGHiLIMITATION AD�ITIONALPLANCHECK <br />OTN[R <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCAL SALES <br />TAX CODEIS 3105 roTn� <br />M E.A. <br />BURNING) <br />iTAL 5 <br />f $ <br />FE[ 5 <br />PECEiPT NO <br />0 <br />; <br />